When people hear the word “ultrasound,” they probably first think about new moms and those blurry yet adorable images taken in utero of their little bundle of joy.
But that’s not all ultrasound is good for. Not by a long shot.
St. Tammany Health System, for example, is leading the way with the use of musculoskeletal ultrasound, a tool used to strike back against the opioid epidemic by speeding the diagnosis of an injury and thus reducing the need for pain medication.
STHS Director of Outpatient Operations Jay Morange has been central to the health system’s adoption of this game-changing new modality, which is just starting to catch on in the United States. Recently, he paid a visit to The Lake 94.7-FM studios to chat with host Charles Dowdy about the MSK ultrasound program at St. Tammany.
Listen to their conversation in the embedded audio player below or at The Lake 94.7-FM website. You can also scroll down for a transcript of Jay’s visit, edited lightly for length and readability.
Charles: St. Tammany Health System in the studio on a Thursday. Tim is here with Jay Morange. I hadn’t seen him in a minute. When were you here last?
Jay: Maybe been a year. Six months to a year.
Charles: All right, so who are you and what do you do?
Jay: My name is Jay Morange. I am the director of outpatient operations for St. Tammany Health System.
Charles: And what does that mean?
Jay: I am over clinical operations for our Outpatient Pavilion and our Mandeville Diagnostic Center, as well as our Wound Care Clinic at St. Tammany Health System.
Charles: All right, how many people are roughly involved in this? How many people do we see? What does the staff look like? Who works for you?
Jay: The Outpatient Pavilion is our big diagnostic clinic. We have over 65 colleagues working there on a daily basis offering a multitude of services like radiology, lab, wound care, pre-op, cardiac and pulmonary rehab, coumadin clinic.
Charles: A lot!
Jay: It is an all-encompassing building. Some days we see between 250 and 300 patients. So, it is a busy, busy clinic.
Charles: You mentioned off the air that your kids are listening to Lake Loot, so what have we got? How many?
Jay: I have got three kids. A 7-year-old, a 6-year-old and a 2-year-old little girl.
Tim: You know, Jay looks a little tired. He just came back from a trip with the Mouse.
Charles: Is that right?
Jay: Yes, the Mouse was busy.
Charles: I hope you paid for the Mouse in advance, because that is a pricey trip.
Jay: Yep, steep price for sure.
Charles: Before that, you went somewhere else. I want to talk about that real quick.
Jay: Yes so, we went back in March to Chicago. We were invited – myself; Bert Lindsey, our director of Inpatient Rehab; and Ashley Wilson, our pharmacy manager – we were invited through the American Hospital Association to present at their national convention for clinical care, to present on our program at St. Tammany for our opiate program.
Charles: Tell me what this means. Your opiate program. Get into that.
Jay: So, we started back in 2015, and from there it has just flowered into just a lot of innovation at St. Tammany with some groundbreaking clinical things we have done. But also, just some really good results, starting with hand-in-hand work with the pharmacy and our team in the hospital for pharmacological alternatives to opiates – but also nonpharmacological alternatives to opiates with a therapy program.
Charles: Why do we need? I know the answer, but I want you to answer. Why do we need alternatives to opiates?
Jay: Well, we all – everybody in the room – could figure out they have been touched in some way by the opioid epidemic, either directly or indirectly. So, at St. Tammany we knew we had to address it. Locally, unfortunately our parish has suffered greatly from this epidemic. We knew we had to answer the call. So, that is what we did at St. Tammany.
Charles: And what is the answer? How have you done this? What have you done?
Jay: From our administration down, we have just really kind of brought the team together and brainstormed what are some things we can offer?
From the therapy side of it, we offered our pain management modalities from dry needling, heat, e-stim and cold treatments, and that’s really helped. Through that process we figured out another innovative modality, which is musculoskeletal ultrasound. That’s what we have really been working on the past couple years, to dive in and study this new modality that is new to therapists and really new to America. It really hasn’t been opened up until the last 5 years here in the States, but it as far as globally it has been around a long time.
Charles: All right, “musculoskeletal ultrasound”: What does that mean?
Jay: So, we are using it from a diagnostic capability. Say you have an injury. You are playing golf on the weekend, and you say, “Man, my elbow is tweaked. It hurts. Hey, Jay, can you scan me?” We use it almost like a screening. Just to say, “Hey, let’s see what you have got going on.”
The advancement of that technology has really allowed us to understand and get a quick, real-time diagnosis right there on the golf course or on field or in the clinic several days later. We can point you in the direction you need to go. Do you need to see the orthopedist? Do you need an MRI? Do you need to see therapy? Do you need all three?
That ultrasound really has allowed us to understand and see what’s going on, because with insurances and payers of sorts, you are not allowed to do those advanced consults without going through a few steps that may take a certain amount of time. And with that, you are in pain. So, what do you have to do to bridge the gap in that pain? You have to resort to pain medicines – and that is where we have had this uptick in addiction.
Charles: You really are on the cusp, the forefront of what you are doing. But it’s something that’s starting to pick up around the country, right?
Jay: Oh, yeah. Ultrasound has really taken off. In the past two years I have invested a lot of time working to find educational resources not only to train myself but the staff around me that’s embarked on this journey with us. We have 14 physical therapists that have been working on this for the past two years, all in preparation to take a board certification through a national board for physicians and advanced practitioners.
Charles: Recently you did a screening event. I think this is a good example of exactly how this can be implemented and ways it can help. You did a screening event at a tennis tournament.
Jay: Yes, the Maudi Tennis Classic at Stone Creek about a month ago. We screened probably 40 to 45 patients in a few hours. Being able to point them in different directions: “Yeah, you probably need to go see an orthopedist or a pain management physician that can do an intervention.” Or, “Hey, just do some therapy” or, “No, that is just soreness. You are good. Keep playing.”
The mental release on those patients was like, “OK, wow, I really have this result right here fast. I can understand what is going on with my body and I know my next step to get better.”
Charles: All right, so I have got an issue. Let’s say something is wrong with my elbow. Do I come straight to you? Do I have to go to a doctor to get doctors orders first? How does that work?
Jay: Typically, you will probably go see your primary care doctor and they will address and see what’s going on with you. There, they can order an ultrasound and we can scan you in our diagnostic clinics. If not, an orthopedist would refer. But, yeah, we have to have a doctor’s referral to perform the ultrasound. If it is a screening event, that’s a different thing. That is a free modality we are offering at a certain thing to try and promote this.
Charles: So the idea is, somebody gets hurt, and between the time they get hurt and really get active treatment or diagnosis, they might be on pain pills – and that is a real problem. It’s that simple, right?
Jay: In a nutshell. And that timeframe is sometimes four weeks. You are four weeks with a muscle tear. I don’t know if you have ever torn a muscle before, but I have. It is immense. So being able to use this diagnostic tool to cut down on that time frame is really the innovation here at St. Tammany. It goes hand in hand with us trying to reduce the exposure to opiates.
Charles: All right, this has been a good conversation. Thank you for the information.
Jay: Absolutely.
Charles: All right gentlemen, thank you for the visit we will talk to you again real soon.